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Changes in use of LHRH agonists between 2003 and 2005 and related matters

Posted Nov 04 2010 12:00am

Financial disincentives related to prescribing of LHRH agonists introduced in 2003 have clearly been associated with changes in actual physician prescriptions for drugs like Lupron and Zoladex in the immediately following years. This is an “old” story to long-term prostate cancer “watchers” but it may be news to newer readers.

Rather than rehash this relatively well-documented story in detail, we refer readers to the following:

A new article by Shahinian et al. in this week’s New England Journal of Medicine.

One of the more interesting comments associated with this story today, however, is a quote from the Chairman of the Scientific Advisory Board to The “New” Prostate Cancer InfoLink. In the HealthDay story mentioned above, Dr. Judd Moul of the Duke Prostate Center suggests that high levels of use of other forms of diagnostic and treatment methods used in prostate cancer may also be associated with their potential for high levels of physician and institutional reimbursement.

“Clearly, there are other areas where this would occur, even in other areas of prostate cancer right now. For instance, proton beam radiation therapy reimburses very well so there are certain medical centers that are really pushing it,” Dr. Moul is quoted as saying in the HealthDay report. “Another classic example is imaging. CAT scans reimburse pretty well so a lot of doctors put CAT scan units into their offices. That’s a profit center.”

It would be naïve to think that “commercial” medicine does not have revenue and profit motives. However, it is disturbing when it becomes distinctly apparent that the levels of use of specific types of care are tied to more than just the appropriateness of that type of care, and that there are purely financial reasons that drive up the numbers of patients who are actually recommended for such treatment. Physicians constantly deny that their prescribing behavior is ever influenced in this way, but quite clearly it can be and is.

The wise patient should sometimes ask firmly whether certain types of test or treatment are really necessary. In the case of imaging, it is well understood that there are significant risks for new cancers associated with the over-use of things like X-rays, CT scans, MRIs, etc.